The CDC reports that over 38 million Americans live with diabetes, predominantly type 2. Given its prevalence, it’s reassuring that Medicare offers support in managing it, covering screenings and services to mitigate type 2 diabetes risk. Explore Medicare’s coverage for vital diabetes supplies, medications, and services.
Medicare Part B and Diabetes
Under Medicare Part B, the medical insurance component of Original Medicare, most services and supplies required for diabetes management are covered, although not all. These must be prescribed by a Medicare-enrolled healthcare provider. Here’s a summary of what Medicare Part B encompasses for diabetes:
- Blood sugar testing supplies
- Non-disposable insulin pumps
- Therapeutic shoes
- Diabetes screening
- Diabetes Prevention Program
- Diabetes Self-Management Training
- Other services such as foot and eye exams
Next, we’ll delve into each category for a more comprehensive understanding.
Blood Glucose Testing Supplies
Under Part B, a variety of self-testing supplies are covered as durable medical equipment (DME). After meeting your Part B deductible, you’ll pay 20% of the expenses. Covered items consist of:
- Monitors for blood sugar
- Test strips
- Lancets and lancet devices
- Solutions for glucose control to verify the accuracy of testing supplies Limits may apply to the frequency and quantity of these items. Medicare may cover a continuous glucose monitor (CGM) and related supplies if you check your blood sugar frequently and use insulin regularly.
Insulin Pumps
It’s essential to note that Medicare covers insulin differently based on the administration method. Traditional external insulin pumps are covered under Part B as DME, along with the insulin. Injectable insulin or disposable insulin pumps fall under Medicare Part D (or Medicare Advantage plans with prescription drug coverage). In either case, the member’s cost is capped at $35 per month.
Therapeutic Shoes
Part B includes coverage for therapeutic shoes or inserts if you have diabetes-related foot conditions. A healthcare provider must prescribe and fit the shoes properly. Once your Part B deductible is met, you’ll pay 20% of the cost.
Diabetes Screening Tests
Part B covers up to two screenings annually for individuals at risk of developing diabetes, provided certain health conditions are present. There are no copayments or deductibles for these screenings.
Diabetes Prevention
Eligible individuals meeting specific criteria related to fasting blood sugar levels and BMI may qualify for a diabetes prevention program under Part B. This program, focusing on lifestyle changes, aims to prevent type 2 diabetes onset. Coverage is provided once per member, with no Part B deductible or copayment.
Diabetes Self-Management Training
Upon diabetes diagnosis, you may qualify for a self-management program offering education on medication usage, exercise, complication prevention, and more. Medical nutrition therapy is also available under Part B, with a 20% cost-sharing after meeting the deductible.
Other Services
Part B covers additional screenings and services for those with diabetes or associated risk factors. These include eye exams, glaucoma tests, foot exams, and hemoglobin A1C tests. After meeting your Part B deductible, you’ll pay 20% of the costs.
Medicare Part C and Diabetes
Offered by private insurance companies, Medicare Advantage Plans cover all aspects of Part A and Part B and often extend coverage to additional services. These plans may offer enhanced benefits for diabetic supplies, medications, and wellness programs, with benefits and costs varying by plan.
Some Medicare Advantage companies also provide special needs plans, such as Chronic Special Needs Plans (C-SNPs), tailored to offer specific benefits and services for members managing long-term health issues like diabetes.
Medicare Part D and Diabetes
Medicare Part D, an optional plan available to all Original Medicare enrollees, assists in covering prescription drug expenses. Part D covers:
- Insulin administered via injection or inhalation
- Anti-diabetic drugs for blood sugar control
- Injection supplies like needles, syringes, and alcohol swabs Monthly insulin costs under Medicare Part D or Medicare Advantage plans with prescription drug coverage (MAPD) are capped at $35, without a deductible requirement.
However, a Part D deductible and copayment may apply to anti-diabetic drugs and injection supplies.